OVERJUSTIFICATION EFFECTS IN TOKEN ECONOMIES

This study tested the relevance to clinical token economies of the overjustification hypothesis that tangible reward interferes with intrinsic interest in target behaviors and causes such behaviors to be less probable following a period of reinforcement than preceding such a period. The study was carried out in an ongoing token economy for chronic psychiatric patients. Alternated over an 8-week period were weeks of token and no-token reward for one of the program's target behaviors, toothbrushing. Two different amounts of token reward were employed in order to examine whether reward magnitude might influence the presence or extent of overjustification effects. Little evidence was found for the presence of overjustification effects in token economies. However, maintenance of toothbrushing was greater in no-token weeks following weeks of low amounts of token reward than in no-token weeks following weeks of higher amounts of reward. The importance of such complex functional relationships is discussed.     

New assessment systems for residential treatment,management, research,and evaluation: A symposium

An introduction and overview are presented to new observational assessment systems for ongoing assessment and monitoring of both staff and resident (client or patient) functioning in residential treatment programs for emotionally disturbed and mentally retarded adults.Preparation of articles and the research and development on which the articles are based was supported, in part, by Public Health Service Grants MH-15553 and MH-25464 from the National Institute of Mental Health, and by grants from the Joyce Foundation and the Illinois Department of Mental Health and Developmental Disabilities.A symposium presented at the 87th Annual Meetings of the American Psychological Association, New York City, September 1979.     

Systems use to objectify program evaluation,clinical, and management decisions

The utility of the observational assessment systems at different levels — from local clinical to systemwide management — is outlined. An overview is provided of TSBC information applied to individualized problem identification and programming/monitoring, discharge and competency determinations, and both absolute and comparative program evaluation. The utility of SRIC information for prgoramming/monitoring and for staff training and evaluation is outlined in addition to the applied uses of the information of the assessment systems in combination. Once implemented, the continuous data from the systems allow for empirically based self-corrective improvements in the quality of mental health services while automatically providing a basis for legal documentation and accurate cost/effectiveness comparisons of mental health programs.Preparation of this article and the research and development on which the article is based were supported, in part, by Public Health Service Grants MH-15553 and MH-25464 from the National Institute of Mental Health, and by grants from The Joyce Foundation and the Illinois Department of Mental Health and Developmental Disabilities.Presented at the 87th Annual Meetings of the American Psychological Association, New York City, September 1979, as part of a symposium on New assessment systems for residential treatment, management, research, and evaluation.     

INCREASING EXTENDED CARE FACILITY RESIDENTS' ATTENDANCE AT RECREATIONAL ACTIVITIES WITH CONVENIENT LOCATIONS AND PERSONAL INVITATIONS1

Residents of extended care facilities generally exhibit a low level of attendance at recreational and therapeutic activities. Spatial arrangement of rooms, prompting, snacks, and small prizes have been suggested as factors that affect attendance. The present study examined the effects of an extensive system of prompts and the location of activity areas on the attendance of residents at a variety of activities. Twenty-six subjects were randomly selected from the ambulatory population of the facility. The first time each subject entered the activity room during the first 6 min of an activity session their name was recorded. Reliability measures were taken at 10 sessions, with a 95% mean agreement between observers. The variables examined were the amount of individualization of subjects (experimental group I: names announced versus experimental group 2: names not announced), room location (central or peripheral), use of names in announcements (activity only versus activity and group I names), and mode of announcement (PA system only versus PA system and in-person). A counter-balanced group design with repeated measures was used, with a randomly determined order of application of experimental treatments. An analysis of variance split plot 2.222 (Kirk, R. E. Experimental Design: Procedures for the Behavioral Science. Belmont, Ca.: Brooks-Cole, 1968.) of the level of subject attendance yielded significant main effects for room location, F(1, 24) = 5.47, p < 0.05, and type of announcement, F(1, 24) = 9.10, p < 0.01, and significant interactions for Individualization × Use of Names in Announcements, F(1, 24) = 5.57, p < 0.05, and Room Location × Mode of Announcement, F(1, 24) = 7.90, p < 0.01. The results indicate that using a centrally located room and announcement of resident names increases attendance at a variety of activities. The increased social and environmental interaction generated by activity attendance has potential therapeutic benefits for the residents involved. Furthermore, the kind of information reported here and by others should be taken into consideration by planners of a variety of group living facilities, ranging from nursing homes to residential treatment cottages.     

Violent behavior patterns on psychiatric wards

A study of 379 violent incidents between pairs of psychiatric inpatients during an eight-month period indicates a substantial number of patterned associations between assaulting patients and those struck. In addition, regularities are observed in these incidents between frequency of occurrence and spatiotemporal and other contextual factors. Taken in the aggregate, these relationships support enlargement of most current conceptualizations of the violent act in psychiatric settings, which focus almost exclusively upon physiologic and psychologic state changes within the identified initiator of violent acts.     

Training Counsellors to Work with People who Live with Cancer: A Needs-led Approach to Planning

This paper traces the development of a cancer counselling service within a voluntary helping agency. The steps of recognizing the needs of people with cancer, identifying multi-faceted desired outcomes and the implementation of one specific goal, that of provision of a counselling service, are outlined. Significant events, stages and decisions made during this process are described and discussed. The emphasis throughout is on the importance of needs analysis and client group consultation in order that the planned service is best placed to meet such needs.     

Archetypal images emerging in the therapy of Lithuanian cancer patients

The goal of this paper is to show through clinical examples how archetypal images connected with nature emerged in Lithuanian cancer patients, to analyze how these images helped them to get in touch with their emotions and meaningful personal experiences, and to discuss how these archetypal images are related to the Lithuanian cultural unconscious, and may also assist the psychological treatment of cancer. The analyzed examples permit the preliminary conclusion that when ill with cancer, a person's psyche generates universal archetypal images that constitute an important part of the process of coping psychologically with the disease.     

The relevance of Rawls' principle of justice for research on cognitively impaired patients

An ethical conflict arises when we must performresearch in the interest of future patients,but that this may occasionally injure theinterests of today's patients.In the case of cognitively impaired persons, thequestion arises whether it is compatible withhumane healthcare not only to treat, but alsoto use these patients for research purposes.Some bioethicists and theologians haveformulated a general duty of solidarity, alsopertaining to cognitively impaired persons, as ajustification for research on these persons. Ifone examines this thesis from the theory ofjustice according to John Rawls, it is revealedthat such a duty of solidarity cannotnecessarily be extrapolated from Rawls'conception of justice. This is at least true ofRawls' difference principle, because accordingto the difference principle only those measuresare justifiable which serve the interest of therespective least well off. Those measures whichwould engender additional injury for the leastwell off could not be balanced by any utilityaccording to Rawls.However, John Rawls' difference principleis subordinate to the first principle,which is that each person has an equalright to the most extensive basic libertycompatible with the same liberty for others.These primary goods are determined by thefreedom and integrity of the person.This integrity of decisionally impaired personswould be in danger if one would abstain fromresearch and thus forego the increase inknowledge related to their disease. Thus onecould conclude, at least from Rawls' firstprinciple, that society must take on a duty toguarantee the degrees of freedom forcognitively impaired persons and thus alsosupport the efforts for their healing.     

Assessment of the Use and Feasibility of Video to Supplement the Genetic Counseling Process: A Cancer Genetic Counseling Perspective

Cancer genetic counselors use a variety of teaching modalities for patient education. This survey of cancer genetic counselors assessed their use of educational videos and their recommendations for content of future videos. Thirty percent of respondents use videos for patient education. Cited benefits included reinforcement of information for clients and increased counselor efficiency. Of the 70% who do not use videos, predominant barriers included the perceived lack of an appropriate video, lack of space and/or equipment, and concern that videos are impersonal. Most respondents desired a video that is representative of the genetic counseling session, but emphasized the importance of using broad information. Content considered critical included the pros and cons of genetic testing, associated psychosocial implications, and genetic discrimination. The results of this exploratory study provide data relevant for the development of a cancer genetics video for patient education, and suggestions are made based on aspects of information processing and communication theories.